A 27-year-old woman with PCOS fails to ovulate despite six ovulatory doses of clomiphene citrate and letrozole. She declines gonadotropins. Which surgical option induces ovulation by reducing intraovarian androgen production?

• A Laparoscopic ovarian drilling with diathermy ✓
• B Ovarian wedge resection via laparotomy
• C Ovarian cystectomy of subcortical follicles
• D Endometrial biopsy with curettage

Explanation

Laparoscopic ovarian drilling uses diathermy or laser to puncture the ovarian cortex, destroying stromal theca cells that produce excess androgen under LH drive. The fall in androgen and inhibin allows FSH to rise and ovulation resumes in about half of clomiphene-resistant women. Wedge resection achieves the same effect but requires laparotomy and carries adhesion risk, so drilling replaced it. Cystectomy and curettage do not reduce androgen production.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.